Welcome to my blog. HIV prevalence is not a reliable indicator of sexual behavior because the virus is also transmitted through unsafe healthcare, unsafe cosmetic practices and various traditional practices. This is why many HIV interventions, most of which concentrate entirely on sexual behavior, have been so unsuccessful.

Tuesday, September 30, 2014

The satirical site The Onion ran the headline 'Experts: Ebola Vaccine At Least 50 White People Away' at the end of July. I'm not citing this article because I think it is funny, but because it raises a shocking point very succinctly, one that must have passed through the minds of many over the past few months.

If such an outbreak were to become established in a wealthy country, mainly inhabited by white people, would it still be raging 9 months later? And what efforts would be made to establish the source of the infections?

Six healthcare personnel were identified as a result of these many, lengthy and thorough investigations. That's an average of almost 20 patients infected for each worker. An estimated 30,000 patients were potentially exposed to blood-borne pathogens by these six people. Twenty three different hospitals were involved, in 10 different states. (Naturally, I don't really know if the victims were all white people; the authors are far too polite to mention such detail.)

So what do we know about unsafe healthcare in African countries, in the absence of such investigations? We know that infants with HIV negative mothers were probably infected through unsafe healthcare in Mozambique, and some of the infants may have gone on to infect their mothers (though it hasn't been seen fit to explain to these mothers how their infants may have been infected, nor even the likely source of their own infection).

We know that people who have received medical injections in Kenya and several other countries are several times more likely to be HIV positive than those who have not. We know that women who have sex only with other women in Namibia and other southern African countries have been infected and that their non-sexual risks have not been investigated. We know that many people found to be infected with HIV in most African countries have said they have not had sex, or that they have not had sex with a HIV positive person, or that they have only engaged in safe sex [earlier version corrected].

Completely untrue, but in accordance with the 'promiscuous African' myth, which has a long history in the medical (and eugenics) literature. The authors of such papers systematically ignore empirical data and fail to investigate outbreaks, they assume that African people themselves are either seriously mistaken about their sexual history or just tell lies, and they go unchallenged by their fellow academics and even peer reviewers, who have the luxury of remaining anonymous, but seemingly prefer to toe the party line.

No doubt these mathematical models are great examples of academic prowess and rigor, that stand up to the highest levels of scrutiny. But they are no substitute for the kind of investigations that have been carried out into what is thought to be a mere tip of the iceberg in hospital transmitted hepatitis and bacterial infections in the US. However brilliant these models are in the field of epidemiology, they are the work of people who care nothing about their fellow human beings in African countries.

Why do these highly qualified academics care so little about poor black people and, apparently, so much about people more likely to be wealthy and white? Is it academic vanity, money, some kind of animalistic competitive instinct, or a combination of these? The challenge to all these clever academics, who can publish their work in the most prestigious journals and be cited in the cream of the western media, is to go to the same lengths investigating and stopping HIV (and ebola, HCV and other diseases) in African countries as they do in parts of the US before the epidemic spreads any further.

Sunday, September 7, 2014

Part VI explored the possibility that family planning and
Sexually Transmitted Infection (STI) services may have been provided in health
facilities that would later be deemed unsafe in the context of HIV, involving
reuse of syringes and other equipment with inadequate or no sterilization. Many
determinants have been identified for STIs throughout the twentieth century,
all over the world. They include poverty, poor education, unemployment, ‘promiscuity’
(Meheus, 1974), low prevalence of
contraception and others. STI prevalence tended to be higher among men than
women, high in both urban and rural areas, higher among unmarried than married
people (Hopcraft, 1973) and fairly evenly distributed
around a country such as Kenya. In contrast, HIV is more likely to be
associated with relative wealth, better education, employment, proximity to
roads and other infrastructure, higher use of contraception, urban dwelling,
marriage and others. More women than men are infected, associations with sexual
behavior considered unsafe are often not very strong and prevalence is unevenly
distributed, with a few hotspots in Kenya and many ‘coldspots’. One might
logically conclude that, while HIV can
be transmitted sexually, it is often transmitted in other ways, and that is why
patterns of infection for HIV differ so much from patterns of infection for
other STIs.

However, there are important overlaps in these patterns of STI
and HIV infection. For example, HIV prevalence was found to have reached 4%
among Nairobi sex workers in 1981 and increased to 61% by 1985; this was
established by retrospectively testing stored blood samples (Piot P, 1987). Females infected with non-HIV STIs in
the past were generally found to be engaged in sex work or had a partner who
had visited a sex worker. Prevalence of STIs was often high in certain
occupational groups, such as transport workers, soldiers and those employed in
extractive industries. As a result, these and other groups had long been
targeted by STI eradication programs; sex workers had also been targeted by
various family planning initiatives. This suggests that those facing high risks
for infection with STIs, or assumed to face high risks, may have had increased non-sexual risk of being infected with
HIV once that virus began to spread (having established itself several decades
before). Although HIV prevalence went up to 81% among sex workers in Nairobi,
it peaked in 1986 and declined steadily for nearly 20 years without any
reasonable explanation being found for this trajectory (Kimani J, 2008). Oddly enough, neither Piot et al nor
Kimani et al consider the very strong possibility that sex workers (and members
of other targeted groups) were systematically infected with HIV through unsafe
healthcare until this risk was eventually recognized (or perhaps changes in
practices reduced the risk of transmission without anyone noticing the impact
this was having on healthcare transmission until much later?).

In the early 80s, no precautions had been taken to prevent
the transmission of blood-borne viruses such as HIV in health facilities, as
the virus had only just been discovered. Throughout the 80s, as it became
apparent that health facility transmission was (or could become) a significant
risk, certain measures were taken to improve safety. But the changes would not
have been adequate to eliminate transmission altogether. In the 90s, as
mentioned in Part III, access to health facilities declined, which may have
inadvertently protected many people from infection; HIV incidence in the
general population peaked some time in the 90s, at a time when visitor numbers
to health facilities would have been falling as a result of increasing poverty,
the introduction of ‘user fees’, cuts in service provision and other factors.
Sex workers and others thought to be ‘promiscuous’ must have faced a very high
risk of being infected with HIV in STI and family planning facilities, although
the risk must have decreased considerably some time in the 80s and continued to
decline, without ever being completely eliminated.

As for those not considered to be so ‘promiscuous’, they
would also have faced high risks in general health facilities. Family planning
and STI facilities were often integrated into general healthcare services.
Women attending antenatal care (ANC) services and giving birth may have faced
higher risk than others (aside from sex workers and other groups targeted by
STI and family planning programs). This makes it less surprising that very high
HIV rates were found in ANC clinics from the late 80s onwards. HIV prevalence
is often highest among women of childbearing age. While these same women may
(or may not) be more sexually active that others among whom HIV prevalence is
lower, they clearly face increased non-sexual risk of infection with HIV at ANC
clinics that are not particularly safe. Family planning services were promoted widely,
often aggressively promoted, and not just to those thought to be ‘promiscuous’.
Family planning, ANC, contraception and even general health services tend to be
more accessible and more utilized in urban areas, by wealthier, better educated
people (Hopcraft, 1973), the very groups found to be more likely
to be infected with HIV. So people with HIV are more likely to have faced
various non-sexual risks, whatever about their sexual risks. Why do UNAIDS and
the HIV industry seem only to consider their sexual risks? Piot et al and
Kimani et al are not exceptional in completely ignoring the possibility of massive
levels of healthcare transmission of HIV; the entire industry has grown out of
denying that unsafe healthcare could have played a part in transmitting a virus
that is a lot less efficiently transmitted through heterosexual sex.

For a long time in Kenya (and other developing countries),
family planning had been seen as a means of ‘promoting economic development’,
as well as ‘improving maternal and child health’. It wasn’t just highly
intrusive and aggressively promoted because it was seen as beneficial to
Kenyans and other Africans, but also because it was seen as a means of reducing
population growth and averting an eventual global shortage of food, water and
vital resources. In the same way that preventing and treating diseases in
developing countries was a way of ensuring a ready supply of cheap labor in
resource rich countries, family planning was seen as a way of controlling birth
rates and population increases beyond what was needed for labor. For many NGOs
operating in African countries now, family planning is development; and ‘maternal and child health’ consists of, pretty
much, family planning. It is seen as something of a truism that maternal and
child deaths can be reduced most readily by reducing fertility rather than,
say, improving conditions in hospitals and elsewhere.

A 1973 paper reveals something about conditions in STI
clinics in Uganda (Arya, 1973).
For a start, it is pointed out that over 90% of the population lives in rural
areas. Therefore, most of the population’s health needs are catered for by
rural health centers, dispensaries and other minor facilities, staffed mainly
by auxiliaries, rather than by more highly trained professionals. Whether it is
because STIs were common or because the colonial and post-colonial
administrations were exceptionally interested in them, Arya argues that
“venereal disease played an important role in the organization of the medical
services in Uganda in the beginning of this century.” Mulago Hospital, started
in the second decade of the 20th century as an STI clinic, became
and remains the largest referral hospital in the country. This is similar to
Kenya, with specialist STI services being available in Mombasa and Nairobi for
many decades. Health expenditure is low, estimated at around one dollar per
year per person in the mid 70s, but basic health services were provided free of
charge. Arya alludes to the lack of success of most STI programs, in both developing
and rich countries, in bringing these diseases under control; he suggests that
there are other diseases that may be in more urgent need of attention. Arya
also notes that private practitioners provide STI services, mainly in larger
towns, and that the quality of these services is unknown.

Arya published a paper in 1976 about the role of medical
auxiliaries in STI control in developing countries (Arya & Bennett, 1976). In common with some
other authors, Arya and colleague draw attention to the high disease burden
faced by developing countries, coupled with the scarce resources, human,
financial and material. These are particularly acute in rural areas, where most
people live, but where well qualified professionals are reluctant to work. The
authors also feel that STI services are mismanaged to the extent that they may
be causing more problems than they are solving, with high prevalence resulting
from “inadequate treatment, improper treatment or no treatment at all”. They
mention high treatment default rates, find the contribution of private
practitioners to STI control ‘questionable’ and conclude that the overall
quality of services is poor. Diagnoses were unreliable (Burney, 1976), patients were receiving repeated
injections of small doses of penicillin, which increased resistance, etc. Another
paper notes the injection of large volumes of penicillin in some countries,
which is likely to have involved the use of glass syringes and reusable needles
in those days (Meheus, 1974). Contact tracing was
generally beyond the capacity of STI service providers. Arya and Bennett
recommend that medical auxiliaries specialize in STIs and that their training
includes “knowledge of the local socio-cultural factors which largely determine
traditional sexual mores” and note that STI patterns “differ from those in the
western nations and may even vary from one area to another within a country”.

The papers cited above and in Part VI give a few insights
into what things were like in terms of STI programs in Kenya and Uganda in the
1970s. Many of those said to be dying of ‘slim disease’ in Uganda in the early
1980s could have been infected with HIV as long as ten years before. If the
rate of new infections peaked in the late 1980s, transmission would have been
increasing throughout the 1970s, reaching its peak in the late 1970s. Why
incidence peaked and then declined is another story. It may have had something
to do with the 1978-1979 war with Tanzania (wars tend to be periods of low HIV
transmission (Gisselquist, 2004)), the civil war from 1981-1986 or, much
more likely, a combination of factors. Incidence began to increase a few years
later in Kenya, perhaps in the mid 1970s, reaching a peak in the early 1990s,
as discussed elsewhere. However, incidence started to increase earlier among
certain groups, such as sex workers, transport workers and others who,
significantly, had been targeted by STI eradication programs for decades. Incidence
also would have peaked and begun to decline earlier in these groups.

Conditions in Kenyan health facilities in the 1970s,
especially those providing STI and family planning services, were poor. If a
blood-borne virus were to establish itself in one or more of these facilities,
there would have been plenty of scope for it to be transmitted widely, not just
among populations aggressively targeted by various health programs, but also
among those requiring other health services, such as antenatal care. The risks
of widespread transmission of HIV in health facilities were not recognized for
a number of years and many more years had passed before any of these risks were
addressed (some have yet to be addressed). But western HIV awareness campaigns
were hijacked long ago by various parties who wished to present the virus as one
transmitted almost entirely through ‘promiscuity’, and who wished to deny the
possibility of transmission in health facilities. Because most of those
infected in African countries were heterosexual, a different story about
transmission needed to be created. Unfortunately, the same campaigns and
strategies were exported from wealthy countries, where transmission was almost
entirely a result of male to male sex or intravenous drug use. These campaigns
were supremely unsuccessful in Kenya, but this was blamed on the failure of
individuals to change their sexual behavior, rather than on any non-sexual mode
of transmission.

If HIV transmission in health facilities and through other
non-sexual modes continues, the virus will not be eradicated. More poignantly,
if health facility transmission had been addressed in the 1980s, when it was
realized that this was a very efficient mode of transmission, the virus would
never have infected so many people. Some of the worst epidemics in the world
only got going in the late 1980s or early 1990s, such as Zimbabwe, Botswana,
South Africa, Swaziland, Mozambique and others. Many of the biggest players
(bureaucrats, politicians, publicists, academics, industrialists, etc)
currently driving the HIV industry have been in the business since the 1980s.
Must Kenyans and other Africans wait till these ‘experts’ are gradually
replaced by more enlightened personages? It is to be hoped that new generations
of practitioners are not obliged to choose between adopting the deeply
engrained institutional prejudices of their profession, or accepting the status
of ‘dissident’ or ‘denialist’, unable to publish, teach or even present their
views to the industry.

REFERENCES:

Arya, O. (1973). Changing patterns in the organization
of the venereal diseases and treponematoses service in Uganda. Brit. J.
vener. Dis, 134-138.

Arya, O., & Bennett, F. (1976). Role of the
medical auxiliary in the control of sexually transmitted disease in a
developing country. Brit. J. vener. Dis., 116-121.

Friday, September 5, 2014

Could sexually transmitted infection (STI) programs that
started many decades before have been involved in the inadvertent transmission
of HIV as early as the 1970s in Kenya? Those targeted by STI programs were
women and men who attended STI clinics, or presented with STIs or STI symptoms.
A short paper by Peter Piot is often cited to show that HIV prevalence went
from 4% in 1981 to 61% in 1985 (Piot P, 1987), and that therefore
sex workers (and their clients) must have been incredibly sexually active, and
also far more efficient at transmitting the virus to men through heterosexual
sex than one might expect (given what has been shown about transmission rates
since then). But the possibility that these sex workers and their clients were
infected through unsafe healthcare practices in STI and other clinics has never
been ruled out.

Jacques Pepin in The
Origins of AIDS argues that early STI programs were almost definitely
involved in spreading HIV (Pepin, 2011) in the Democratic
Republic of Congo. But he uses Piot's paper to argue that sexual behavior took
over from unsafe healthcare at some time; why this happened, or when, is not
very clear. However, the papers below suggest that the very people among whom
HIV prevalence was found to be high would also have been frequent clients in
STI clinics. Conditions in health facilities probably improved during the 80s
and 90s, which would have accounted for the rate of new HIV infections peaking
in the early 90s and subsequently declining. But given that healthcare is not
particularly safe in Kenya now, we don't know if HIV is still transmitted
through unsafe healthcare, albeit at a far lower rate.

Could invasive family planning methods such as intrauterine
devices (IUD), inserted in insanitary health facilities, have been involved in
the transmission of HIV, perhaps also as early on as the 1970s? Family planning
was most accessible and most availed of in urban areas, and the users were more
likely to be better educated, wealthier and formally employed (these are still true
of family planning users). Some of the earliest institutions to work with HIV
in African countries were those involved in family planning. They were already
well established in many countries and persuading people to have smaller
families, through any means possible, was what they knew best. That’s not to
say they were particularly successful, but they certainly received the lion’s
share of funding at one time, until the HIV industry became the top heavy, cash
rich bureaucracy that it is today, where any big NGO that toes the party line
will get ample funding. Perhaps some of the industry’s obsession with sexual
transmission, to the exclusion of most forms of non-sexually transmitted HIV,
relates to their origins, which can include puritanical religious beliefs,
Malthusianism and neo-eugenicism, to name but a few.

Kenya is said to have been “the first country in Africa south
of the Sahara to adopt family planning as a national policy” (Fendall & Gill, 1970), with the earliest
family planning efforts starting in Mombasa in 1952. At first, it was decided
that Kenya’s population growth was not particularly worrying and the policy
started off fairly moderate. There were 25 clinics by 1965 in a country with a
population of about 11 million (as of 1969). But in the early and late 60s,
censuses showed that population growth was about 3%, far exceeding death rates.
An average of 7 children were born to women reaching 50 years of age and
average life expectancy was 40-45 years. Those engaged in family planning
resolved to reduce fertility by 50%, with intrauterine devices (IUD) being seen
as the best contraceptive method for achieving this. Family planning was to be
integrated into public health services and it would be free and voluntary (although
costs involved in attending the clinic were not covered, which may account for
the relative popularity of longer acting methods, which didn’t involve repeat
costs).

The number of clinics had reached 160 by 1970, with the
biggest being set up in urban areas, along with some of the more heavily
populated non-urban areas. Smaller units and mobile teams operated in less
accessible areas (although some of the higher populated areas are not urban,
such as in the Western and Nyanza provinces, where population is also dense). The
Family Planning Association of Kenya claimed to have 17,000 clients in 1965, of
which 70% were urban and 30% were rural. It is possible that independence
interrupted progress that had been made in the previous two decades. With a
growing population and limited revenue, the government needed to provide the
free health service they had promised. But the first 20 years or so of family
planning may have set some of the patterns that continued for the two or three
decades following, and perhaps still exist. Contraception tends to be far more
common in urban areas, among better educated, wealthier, urban dwelling people.

British colonial concern about sexually transmitted
infections (STI) dates back at least to the 1920s and by the 1970s resistance
to antibiotics and penicillin for the treatment of gonorrhea was already common
in rural and urban areas. This may suggest that people with STIs had been able
to access health services for some time, but that those services were not able
to eradicate the most common infections. It is likely that many people did not
return for some lengthier forms of treatment, which could involve a lot of
discomfort, as well as considerable expense from travel and other costs. A
paper from 1971 mentions ‘selected social groups’ being investigated in the
past for resistance, including people in capital cities, harbor areas, ‘special
elite groups’ (whoever they may be), foreign soldiers and ‘hostesses catering
for them’ (Verhagen,
1971).
(These are some of the groups among whom HIV was later found to be highest.)
But the authors suggest that these groups are not representative of the
population as a whole and exclude the majority of gonorrhea patients. It is
hinted that the reason these groups are targeted in Kenya is that they may have
been the groups most likely to be infected in wealthier countries, such as the
UK, but that the analogy didn’t quite work. It is noted that Mombasa and
Nairobi have ‘special VD clinics’, although the one in Mombasa only treats sex
workers, whereas the one in Nairobi also treats the general population.

A paper published the following year aims to establish the
determinants of gonorrhea in Kenya (it is notable that, out of the few papers
available in full, many are about gonorrhea, fewer are about other STIs; also, most
studies tended to be carried out in a handful of countries, with Kenya being one
of the handful). It uses data from monthly checkups for sex workers at the
Mombasa and Nairobi clinics mentioned above (Verhagen & Gemert, 1972). One of the authors,
Verhagen (and perhaps some of his contemporaries), is interesting for being a
lot less judgmental than one might expect, especially given the deep racism
later found in institutions working with HIV. Some questions about sexual
behavior were deemed ‘too intrusive’ to ask people in their control group. UNAIDS’
criteria for ‘sex work’ is often inclusive enough to be applicable to almost
every sexually active person in the country, and even many people who are not
sexually active. The authors also draw attention to the fact that attendance
for all medical services increased rapidly when treatment became free in 1965.

Gonorrhea tends to infect people who may be more ‘promiscuous’,
such as sex workers and their clients. Simple supply and demand would suggest
that sex workers must be fairly small in number, whereas clients need to be
plentiful. As sex workers are usually female and clients usually male,
gonorrhea may therefore be expected to infect more males than females. Verhagen
and Gemert find that the male:female ratio is 2:1 in 1964, rising to 6:1 in
1970 and 8:1 the following year. They note that the ratio for syphilis is
usually around 2:1. The authors are not able to estimate incidence of gonorrhea
but they conclude that Kenya has relatively low incidence, as the disease
globally is said to be currently the most common notifiable disease after
measles.

Despite earlier findings that patients with STIs are “found
among distinct social groups such as the lower social strata, members of
migratory or itinerant professions, and other groups characterized by social
instability”, this paper concludes that there is “a striking similarity between
patients and controls.” Many of the women were single and unemployed (although
many were sex workers) and many people who were married and had STIs spent long
periods away from their partner, this being more a feature of urban, rather
than rural living. Men with STIs usually attributed their infection to someone
other than their wife, while women with STIs were often less well educated, as
well as being single and not conventionally employed, which strongly suggests
that they were very poor. Even among those deemed to be sex workers, it was ‘the
smarter and more expensive girls’ who received the monthly checkup, so they may
have been less likely to be infected with gonorrhea and other STIs than other
clinic patients.

UNAIDS and the HIV industry have a fondness for identifying
(and thereby stigmatizing) multitudes of HIV ‘risk groups’, at least one of
which almost everyone falls into at some time. In contrast, Verhagen and Gemert
assume “that encounters in bars, brothels, dance-halls, and in the street
(termed the BBDS category) were the more casual and usually reflected prostitution
and promiscuity”. This must have made it a lot easier to target people at risk
of being infected with an STI, or of transmitting it to others. The difference
in approach may explain the lack of successful HIV prevention interventions,
especially before the widespread availability of antiretroviral drugs. Half of
the male patients are said to have been infected by someone they met in a
brothel, a bar or a dance hall, with brothels only accounting for 10% of all
gonococcal infections; the other half met the sexual partner on the street or
near where the partner lived. Although the fairly small number of ‘promiscuous’
females infect a larger number of males, fewer of those males go on to infect
another partner, such as their wife. The authors neither conclude that all (or
most) men are promiscuous, nor that all (or most) females are. The phenomenon
of large numbers of single men and married men who live away from their partner,
which was very often the case in cities, and a small group of women to cater
for their sexual needs, is identified as a major driver of high rates of STI
transmission (as it was later said to be in relation to HIV). Even the ‘breakdown
in traditional ethics’ said to result from migration and urbanization, frequently
remarked on later, had been noted by authors several decades before.

Generally, far fewer women than men were infected with
gonorrhea and other STIs. Quite a number of these women were said to be ‘non-promiscuous’,
having been infected by a promiscuous partner. Sex workers are often badly educated,
unemployed migrants whose marriage may have broken down and who come from a
particular tribe associated with these and other factors. Comparing their study
participants with a control group, it is found that many of the males are
young, badly educated, unemployed, living in overcrowded conditions and are
recent arrivals in the study area. The authors warn that “The self-image of an
indiscriminately promiscuous community (which in view of our findings in regard
to the regularly married is wrong), ostracism against prostitutes and emotional
outbursts blaming a particular sex or group of persons are of no help.” That
warning, along with others, was to fall on deaf ears. “No distinct high risk
groups were found” in the course of this study.

The above papers are of interest to a history of HIV in
Kenya because many sexually transmitted infections are a lot less likely to be
transmitted through any other route, such as unsafe healthcare. In contrast,
HIV is relatively difficult to transmit sexually and easy to transmit through
unsafe healthcare, unsafe cosmetic practices and various skin piercing
traditional practices. As I have mentioned in earlier posts, HIV is often
correlated with higher wealth, better education, employment (as opposed to
unemployment) and urban residence, and prevalence is generally higher among
women. Many of the factors involved in the transmission of HIV seem to the opposite of those involved in
transmission of gonorrhea and some other STIs.

What about factors for STIs and factors for HIV that seem to
overlap, such as involvement with sex work, migration, mobility and the like?
The above papers, along with others from the decades preceding the discovery of
HIV, suggest that sex workers, immigrants, transport workers, migrant workers
and those engaged in certain occupations had long been targeted by STI
programs. These programs were most prominent in areas that attracted migrants,
cities and areas with high labor needs. Could some of these programs have been
inadvertently involved in the transmission of HIV to the groups that were later
found to have been infected, as if en
masse? What about family planning? Could the use of IUDs have infected many
women? There is certainly plenty of evidence that conditions in health facilities
were poor, that health facilities were oversubscribed, underfunded,
understaffed and not the safest place to go for preventative or curative
treatment. Even the connections between population growth and density alluded
to by some HIV commentators may relate to the relative success of family
planning and STI eradication programs in urban, as opposed to rural areas. Higher
levels of education and wealth are generally associated with both family
planning and health seeking behavior in general; but while these factors are
associated with higher HIV prevalence, the opposite is true of STIs.

The massive increase in HIV prevalence among sex workers
found in Nairobi, from 4% to 61% between 1981 and 1985, may have been a result
of unsafe healthcare, especially in facilities providing STI and family
planning services. Historical and contemporary studies show that HIV is only
sometimes transmitted sexually; patterns of infection only overlap to a limited
extent with those for STIs. The relative contribution of sexual and non-sexual
transmission to Kenya's epidemic remains unknown; until it is known, epidemics
like that in Kenya will continue indefinitely. Yet the HIV industry is still happy
to accuse those infected of being highly promiscuous, and of being indifferent
about transmitting the virus to their partners and infants.

[The list of publications below is short and I will comment
on other publications in the next part.]